MEDICARE: JAMES PAGDILAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0115822	NY

General Provider Information

NPI Number	:	1427500479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES PAGDILAO

Provider Business Mailing Address
First Line	:	8854 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5804
Country	:	US
Telephone Number	:	718-600-4088
Fax Number	:	347-554-8418

Provider Business Practice Location Address
First Line	:	8854 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5804
Country	:	US
Telephone Number	:	718-600-4088
Fax Number	:	347-554-8418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/25/2016

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